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Vasectomies and Insurance Coverage: What You Need to Know.

by | Feb 21, 2022 | Men's Health, vasectomy and procedure

If you are considering a vasectomy, it is important to know that the procedure is typically covered by insurance. However, there may be some exceptions. Patients need to be aware of their coverage and what is required for them to receive reimbursement. In this blog post, we will discuss the basics of vasectomy insurance coverage and what patients need to do in order to have the procedure covered.

Federal and State Laws

Oregon is one of five states (Oregon, Washington, Illinois, Maryland, Vermont) that requires vasectomies to be covered at no cost to patients. Medicaid (OHP, Care Oregon, etc.) also covers vasectomies.

Timelines

Private insurances typically don’t have a waiting period between when you have your vasectomy consult with your doctor and when you have the procedure. However, most federal or state insurance plans require a 30-day waiting period. If you have federal or state insurance and you undergo your vasectomy prior to the 30-day waiting period it is likely your procedure would not be covered and you would be responsible for the full fee.

Age Restrictions

Most insurance companies won’t cover vasectomies for patients under 21 years old.

Often, doctors will not perform the procedure on someone younger than 25, BUT, every patient’s case is different so don’t let this deter you. If you’re interested in a vasectomy, get a consult to get your questions answered.

Procedure Code

Ultimately, contacting your insurance company and using our insurance verification worksheet is the best way to know if and how much of the procedure will be covered when performed by your doctor at NWIM.

Provide your insurance carrier with the CPT code 55250 and diagnosis code Z30.2.

If you have additional questions, don’t hesitate to schedule your consultation appointment with an NWIM physician today!

Disclaimer

This blog pro­vides gen­eral infor­ma­tion and dis­cus­sion about med­i­cine, health and related sub­jects. The words and other con­tent pro­vided in this blog, and in any linked mate­ri­als, are not intended and should not be con­strued as med­ical advice. If the reader or any other per­son has a med­ical con­cern, he or she should con­sult with an appropriately-licensed physi­cian or other health care worker.
Never dis­re­gard pro­fes­sional med­ical advice or delay in seek­ing it because of some­thing you have read on this blog or in any linked materials. If you think you may have a med­ical emer­gency, call your doc­tor or 911 immediately.
The views expressed on this blog and web­site have no rela­tion to those of any academic, hospital, practice or other insti­tu­tion with which the authors are affiliated.

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